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- A 36-year-old woman is diagnosed with mild-stage pelvic endometriosis at diagnostic laparoscopy. She has regular menstrual cycles. Her partner has normal semen analysis. The couple have been trying to conceive for 2 years. Which one of the following management options is the preferred initial treatment choice?
- The commonest pathology identiﬁed at diagnostic laparoscopy in patients with chronic pelvic pain is:
- A 26 years old woman presents with complaints of dyspareunia. She has been having a painful period for the past 1 year, and the pain has increased lately. She has some vaginal discharge which is not foul smelling or associated with pruritus. She also complains of becoming irritable during her periods in the past few months. Speculum examination reveals the presence of blue nodules in the vagina. What is the most likely diagnosis?
- In cases of infertility:
- A 38 years old and suffers from primary infertility and endometriosis. Her recent TV scan suggests the presence of a 2.5 cm endometrioma. Her pain is well controlled using simple analgesics. She is due to undergo IVF. Which treatment is best suited to deal with her endometrioma?
- A 43 year old woman is having a diagnostic hysterolaparoscopy as part of the investigations for abnormal uterine bleeding. During laparoscopy, you see an ovarian cyst in the left ovary which is possible for an endometrioma. You have taken consent only for diagnostic hysterolaparoscopy. What is the most appropriate course of action?
- A 26 years old woman presents with complain of new onset vaginal discharge. She is sexually active and uses condoms for protection against STIs although she has been regularly using the pill for the last 6 months. She is particularly worried because she has had postcoital spotting in the last few weeks. Her Pap smear done last year was normal. Speculum examination reveals the presence of an erythematous raw- looking cervix. What is the most likely diagnosis?
8.A couple have been trying to conceive for 2 years. The 34 yrs old male partner semen analysis shows: Volume 1.5ml, 23 million sperm/ml, 42% motility and 5.1% normal forms. Female 25 yrs old, has regular periods every 28 days. FSH,LH and day 21 progesterone are all within normal limits. Pelvic ultrasound was normal 1 year back. She reports getting some antibiotics for vaginal discharge 3 years ago. Her BMI is 24.5 kg/m². Physical examination of both partners is unremarkable. What wil you do next?CorrectIncorrect
9.Acouple have been trying to conceive for 2 years. The 28 years old male partner semen analysis shows: Volume 1.6ml, 16 million sperm/ml, 50% motility and 4.5% normal forms. The 25 years old Female partner stopped COCP 2 years ago. She was taking this for dysmenorrhoea and she has noticed her period pains have been getting progressively worse since stopping but they are regular every 28 days. FSH, LH and day 21 progesterone are all within normal limits. Her BMI is 28.5 kg/m². Physical examination of both partners is unremarkable. What is next best option?CorrectIncorrect
10.A 30 year old patient complains of an 18 month history of pelvic pain that intensifies around the time of her period and in the past 3 months has started radiating into the back, what is best for her?CorrectIncorrect
11..A 29 year old patient attends clinic with her partner due to failure to conceive after 18 months. STI screen is negative, hormone profile is normal and her partners semen analysis is normal. Her BMI is 25 kg/m². Both her and her partner are non‐smokers. Pelvic ultrasound shows a left sided endometrioma. How will you manage this patient?CorrectIncorrect
- A 30 year old woman has been trying to conceive for 2 years. Her partner’s semen analysis is normal as is her hormonal profile, tubal patency test and pelvic ultrasound. Her luteal phase progesterone is ovulatory. She had deep dyspareunia and mild dysmenorrhoea and had a laparoscopy where peritoneal endometriosis was ablated 6 months ago. ASA Stage 1 endometriosis was diagnosed. What should be the next line of management?
- A 38 year old woman suffers from dysuria, severe frequency, nocturia and urgency. She also complains of pain or pressure in the suprapubic area. She has been treated with antibiotics for suspected UTI in the past by her GP. On 3 occasions, MSU revealed ‘mixed growth’. She has deep dyspareunia and the pain persists for a few days after intercourse. Bladder capacity is around 400 ml. Initial cystoscopy was normal but on repeat filling, some petechial haemorrhage was seen.What is the most likely diagnosis?
14.What is the estimated prevalence of endometriosis in infertile women?CorrectIncorrect
15.Ms XY is 38 years old and suffers from primary infertility and endometriosis. Her recent TV scan suggests the presence of a 2.5 cm endometrioma. Her pain is well controlled using simple analgesics.She is due to undergo IVF. Which treatment is best suited to deal with her endometrioma?CorrectIncorrect
16.A 35-year-old para 3 underwent a TAH+BSO for severe pelvic endometriosis that had not responded to medical and conservative surgical treatment. She attends for her follow-up appointment complaining of hot flushes and sweating. Which HRT regime should you consider?CorrectIncorrect
17.A 31-year-old lady presents with secondary subfertility. She had difficulty conceiving her first child and has now been trying for 4 years. She gives a history of cyclical premenstrual pain, painful periods and deep dyspareunia. Her day 21 progesterone is 38 nmol/L with normal levels of FSH and LH. What is the most likely cause?CorrectIncorrect
18.A 32 years old P2L2 comes with the complaint of dysmenorrhea and dyspareunia and on and off dyschezia since 5-6 months . She is not able to recall when she gets more of the Pain .What will be your next advise ?CorrectIncorrect
- A 25 year old presents with lower abdominal pain of 12 months duration. The pain is worse around her menses, which are also heavy. Sexual intercourse is painful. She has altered bowel habits especially around menstruation. You suspect that she may have either irritable bowel syndrome or endometriosis or both. What approach will you take to differentiate between the two conditions?